201 - Variations in Clinical and Laboratory Presentation of UTI in Medically Complex Patients

Poster Number: 201
Publication Number: 201.143

Mallika B. Iyer, University of Washington School of Medicine, Seattle, WA, United States

Background: In medically complex children (MCC), evaluating for urinary tract infections (UTI) can be complicated due to vague and nonspecific presentation. The current American Academy of Pediatrics criteria for UTI diagnosis is based on findings in otherwise healthy children, thus this poses an issue for MCC. Medically complex children are those who have multiple or specialized health needs. A complicating factor for both healthy and MCC patients is the difficulty in verbalizing symptoms, which may lead to confusion around diagnosis.

Objective: We sought to describe urinalyses and clinical presentations in symptomatic children with varying levels of medical complexity, and we sought to how UTIs are treated in both MCC and non-medically complex children.

Design/Methods: A retrospective cross-sectional analysis was performed of all patients admitted to a single freestanding children’s hospital with an ICD-9 or ICD-10 diagnosis of UTI (cystitis or pyelonephritis) from January 1, 2018-December 31, 2019. Demographic data were collected, as were urinalysis characteristics and culture results. Continuous data were assessed with measures of central tendency, and comparisons among groups of MCC (chronic complex [CC], non-chronic complex [CC] and non-complex [NC]) were performed using t-tests and analyses of variance, while proportional outcomes were assessed using chi-square and Fisher’s exact tests.

Results: A total of 119 patients had 133 admissions. Males comprised 47.1%, 17.6%, and 23.5% of CC, NCC, and NC patients, respectively (p=0.10). CC patients were significantly older (median age 11.1 years) than NCC or NC patients (median age 4.2 and 7.0 years, respectively; p=0.0035). While patients in all three groups were equally likely to be febrile, CC patients (35.4%) were less likely than NCC (82.4%) or NC (70.6%) patients to have vomiting/nausea (p < 0.0001). Elevated CRP was more often seen in NC patients (75%) than in CC (18.2%) or NCC (33.3%) patients (p=0.007), while pyuria was seen in fewer NCC (47.5%) than CC (70.7%) or NC (73.5%) patients (p=0.02). Three patients had negative urine cultures. All patients received a 10–14-day antibiotic course (82% orally).Conclusion(s): CC patients presented with symptoms less likely to align with “typical” UTI symptoms; however, the finding that three patients had negative urine cultures underscores the need for comprehensive evaluation of all children with suspected UTI. Clinicians must be aware of variations in UTI presentation and balance prompt initiation of therapy with the potential harms of antibiotic administration.
Inflammation MarkersInflammation Markers by percent in MCC vs non-complex children
OrganismsOrganisms cultures amongst the three groups (non complex, non-complex chronic, and complex chronic)